E. Wittke-Michalsen

In principle, leech therapy does not have to be performed at any specific time of day. However, for organizational reasons, it may be better to apply the leeches in the early morning or during the first half of the day because it sometimes takes up to two hours for the leeches to finish feeding. Morning appointments also ensure that the patient can be monitored for several hours and that the practice will be open for questions and additional care when needed. Patients who are reliable and experienced in monitoring the leeches themselves can be scheduled for afternoon appointments when only a few leeches are to be applied.

Certain weather conditions can affect leech behavior. For instance, it may be difficult to get the leeches to feed when it is very humid or when a storm is brewing. Great patience may be required. Humidity and barometric pressure changes can also affect patients with low blood pressure, who may develop autonomic dysregulation and circulatory problems.

The actual leech application procedure and related measures should be organized in such a way that the work can be done quietly and efficiently without pressure of time. The leech therapist should not be pressed for time. Otherwise, nervous agitation could spread from the therapist to all other parties involved.

In treatment preparation, it is very important to explain the treatment procedure in detail so that the patient will know exactly what to expect and what to do during and after leech application. Measures to reassure and relax the patient are also well taken. Overanxiety frequently causes sympatheticotonia, resulting in a drop in blood flow and temperature in the extremities. This makes it harder to get the leeches to feed in peripheral sites (e.g., hand and foot joints), as we know from experience. Heat treatments to warm the target area prior to leech application can then be helpful (see below).

Fig. 4.1 Materials required for leech therapy. These materials should be gathered before starting treatment

Perfumes, chemicals, and local drugs should not be applied to the skin at the intended application site for at least two days before treatment. Disinfecting the application site is not helpful because leeches are sensitive to strong odors and may not bite. It is not possible to achieve aseptic conditions without killing the leeches, anyway. It may be necessary to shave the application site if it is located in a part of the body that is densely covered with hair; it should then be shaved cleanly because sharp stubble can hinder the leech. Afterward, rub dry until the skin is rosy–hyperemization helps to get the animals to bite more quickly. Other measures to stimulate the blood flow and soften the skin (hot sponge or compress, red light, bathing the arms or feet in warm or hot water) can entice the leech to feed more quickly but are seldom necessary except when treating peripheral sites such as the joints of the foot or hand (e.g., for rhizarthrosis). Cupping is another suitable means of stimulating blood flow before treatment. Wetting the skin with water makes it easier for the leech to attach its suckers and can therefore facilitate feeding. Mostly, it is not necessary to “lure” the leech with sugar water.

Leech Selection

The leech therapist should only use healthy and active leeches—not those that are in the process of molting or resting lethargically at the bottom of the container. The ideal leech:

• Swims about quickly and lively in the water,

• Attaches to the handler’s hand immediately when it is put in the container,

• Immediately draws up into an “O” shape when touched, and then extends the head region forward in searching movements.

Small to medium-sized leeches should preferably be used because the bites of smaller leeches are less painful and tend to heal faster.

The leeches should be taken out of the container by hand. Surgical gloves protect the handler from being bitten. A compress may make it easier to grasp the leech. If a leech attaches to the glove, then carefully remove the sucker. Never use tweezers or sharp instruments that could injure the leech. When treating a relatively large target area, for example a broad region of pain on the back (dermatome), several leeches can be applied at a time. Hold a large compress in one hand and place one to three leeches on the compress, then apply the leeches gently to the target area and hold down the edges of the compress. Release the compress after the patient has sensed multiple bites or local pain and rhythmic, pulsating movements can be seen in the curved neck of the leeches. Keep the target area warm and dark by loosely covering it with a towel or other material.

When treating a small target area, the leeches have to be applied one at a time. Grasp the tail region of the leech between the thumb and index finger (gently!) using a compress if necessary, and lower the head (more narrow, tapered, seeking end) to the target site. Keep guiding the leech back to the target site until it bites and starts to feed. Wetting the application site with water sometimes helps to make the leech bite faster.

If the leech attaches its sucker in the wrong place but has not bitten yet, the handler can carefully insert a fingernail under the edges of the sucker to detach it. Another good trick is to cut a hole in adhesive film and tape the film so that the hole is located over the intended application site (e.g., the thumb joint in patients with rhizarthrosis). A small glass tube, a disposable syringe with the bottom cut off or a small cupping glass can also be used to selectively apply one or more leeches to one or more target sites. Before removing the cupping glass, the handler should check to make sure that the leech has not started feeding yet.